Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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In order to evaluate the effectiveness of an intensive care unit (ICU), the case-mix has to be considered. This was a cohort study. By using Acute Physiology and Chronic Health Evaluation scores (APACHE II score), we evaluated the case-mix and mortality rate of 282 patients who were treated in our postoperative ICU. ⋯ We used stepwise logistic regression to determine the predictors of death and found the prediction model to be -7.24 + 0.37 (APACHE II score) + 1.46 (postemergency surgery). The actual mortality for patients with APACHE II score > 15 in our ICU was higher than that predicted by the original APACHE II model. The causes of this difference might be difference in methodology, characteristics of ICU and the quality of care.
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The study of tracheal extubation time in pediatric patients who underwent open heart surgery was performed in the period of 1990-1991 (group 1) and 1992-May 1994 (group 2), composed of 174 and 208 cases in group 1 and group 2 respectively. The criteria for extubation in these patients are convention regimens with considered subsequent standard of CPB, such as fully rewarmed, hemodynamic stable with adequate cardiac output with low-dose or no inotropes/ vasodilator, without significant dysrhythmias and no significant mediastinal bleeding. The difference of postoperative fluid management between the two groups include the regimens of total fluid intake of two-thirds of daily maintenance fluid in group 1, whereas, the total fluid therapy of group 2 depended on the patients' age and body weight. ⋯ The prior etiology occurred in group 1 more than group 2. It was concluded that, after the change in postoperative fluid therapy regimens, early extubation following open-heart pediatric surgery is highly successful with no significant complication. The benefits of early extubation include cost savings, patient comfort, early patient mobilization, improved cardiac function, reduced respiratory complications and reduction of case cancellation due to early ICU discharge.
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Comparative Study
Comparison of DNA targets for amplification by polymerase chain reaction for detection of Mycobacterium tuberculosis in sputum.
PCR assays for detection of Mycobacterium tuberculosis were compared using three different primer pairs to amplify fragments of IS 6110, pab and mtp 40 genes. The amplified products were detected by gel electrophoresis. The detection limit of PCR assay for amplification of IS 6110, pab and mtp 40 genes was 10,100 and 100 femtograms of purified M. tuberculosis DNA, respectively. ⋯ The one that grew MOTT was PCR-negative. Of 53 culture-positive found to contain M. tuberculosis, amplified products were detected in 47 (90%), 28 (53%) and 17 (30%) samples in which the target for amplification was IS 6110, pab and mtp 40 genes, respectively. This study confirms the potential of IS 6110 amplification by polymerase chain reaction for rapid detection of M. tuberculosis in clinical specimens.
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Case Reports
Bullet embolus to the right pulmonary artery after abdominal gunshot wound with "piggyback bullet".
This report describes a 17-year-old man with piggyback bullets to the abdomen followed by bullet embolization to the right pulmonary artery. The first bullet was removed from the abdomen while the second missile in the lung was left intact. We believe this is the first case in Thailand of a bullet embolus resulting from piggyback bullets.
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Randomized Controlled Trial Comparative Study Clinical Trial
Topical analgesics, indomethacin plaster and diclofenac emulgel for low back pain: a parallel study.